Although this stepwise strategy is aimed at identifying those most likely to have significant coronary or arterial diseases, in reality the picture is quite different. One study has shown that of 136,905 people presenting with coronary diseases, 77% had normal low-density lipoprotein (LDL) levels.2 Another study has shown that 22.4% of Cabozantinib research buy patients who suffered an initial heart attack and took statins to aggressively lower their cholesterol levels suffered a repeat event (including death from any cause, myocardial infarction, documented unstable angina requiring rehospitalization, Inhibitors,research,lifescience,medical revascularization,

or stroke) within 2 years despite having an LDL level of 62 mg/dL.3 An additional study has shown that the correlation between cholesterol levels and mortality from coronary diseases depends on geographical location.4 For example, in Japan, unlike the United States, Inhibitors,research,lifescience,medical little correlation was found

between cholesterol levels and mortality rates. The risk of a Japanese individual having an MI was similar both for people who had higher cholesterol levels and for people who had lower cholesterol levels. Four separate studies have shown that Inhibitors,research,lifescience,medical there is a relationship between stressful events such as earthquakes, missile attacks, stock market fluctuations, and even soccer matches and the incidence of acute coronary syndrome.5–8 Such events do not change cholesterol levels or the other classical risk factors, yet they may trigger an MI and sudden cardiac death. Even imaging the inside anatomy of the coronary Inhibitors,research,lifescience,medical arteries does not ensure predictability. After performing an angiogram on a group of patients, the predictability as to which patient would be the first to Inhibitors,research,lifescience,medical have an MI and where it would occur in the coronary arteries was low.9–12 Therefore, we must conclude that there are other risk factors involved

in causing the onset of MIs, and we are missing functional tests that can pinpoint patients at risk for coronary heart diseases and sudden cardiac death. THE PREDICTIVE Linifanib (ABT-869) VALUE OF ENDOTHELIAL FUNCTION Acute coronary syndrome and sudden death is a dynamic process. The process occurs at the interface between the vascular wall and the circulating blood. Thus, it is important to develop a test that measures vascular function, not one that just measures cholesterol levels or takes images of the arteries. If an intact blood vessel is put into a glass vessel and acetylcholine is added to the buffer, a relaxation of the blood vessel will occur. However, if there is an injury to the endothelial layer of cells or the blood vessel, this reaction will not happen. The main molecule that mediates this reaction is nitric oxide (NO). Not all vessels or blood vessel segments react in a similar fashion.